Organization
KATHLYN NELSON PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KATHLYN ELVERA NELSON PHD (SOLE PROPRIETOR)
(651) 341-9667
Entity
Organization
Contact information
Practice address
7616 CURRELL BLVD, STE. 280, WOODBURY, MN 55125-2290
(651) 341-9667
(651) 735-7527
Mailing address
2546 DOROTHY AVE, WHITE BEAR LAKE, MN 55110-4911
(651) 341-9667
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP 3967
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1093804338
INDIVIDUAL NATIONAL PROVIDER IDENTIFIER
MN
05
—
459510600
—
MN
Enumeration date
08/18/2009
Last updated
08/18/2009
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